Strongly recommending a re-configuration of the entire health system where the government will have a major role to play, a high level expert group on Universal Health Coverage (UHC) has proposed making health care an entitlement to every citizen.
The group suggested that health care be offered as a National Health Package (NHP) covering all common conditions and high-impact health care requirements including in-patient and out-patient care free of cost.
Describing general taxation as the most viable option for mobilising resources to achieve the target of increasing public spending on health and creating mechanisms for private protection, it favoured a surcharge on salaries or taxable income to pay for the UHC and offer cashless health care to all sections.
According to the panel, the health care services would be made available through the public sector and contracted-in private facilities (including the non-government organisations and non-profit groups). These service providers would not be allowed to accept any additional payments from individuals or through privately purchased insurance policies for non-NHP services. Private providers opting for inclusion in the universal health coverage system would be reimbursed at standard rates as per levels of services offered to the population, and their activities appropriately regulated and monitored.
Financing the proposed scheme will require public expenditure on health to be stepped up from around 1.2 per cent of gross domestic product (GDP) now to 2.5 per cent by 2017 and to 3 per cent of GDP by 2022. “Increased public expenditures, in our estimate, will lead to a sharp decline in the proportion of private out-of-pocket spending on health from 73 per cent at present to 33 per cent by 2022,'' according to the draft report submitted to the Planning Commission of India
‘No distinction'
“We have made no distinction between the poor and the rich as that would have brought down the quality of health care as the rich or those who make and implement policies would have no stake in it. On the other hand, the participation of the rich will be ensured by taxing them to fund the health coverage,'' K. Srinath Reddy, president of the Public Health Foundation of India said. Dr. Reddy chairs the expert group that has also suggested integration of all government-funded insurance schemes with the UHC system; replacement of all insurance cards by the National Health Entitlement Cards, and removing conditionalities, specifically two-child norms for maternity or other benefits, from all health programmes so as not to punish women and girls for behaviour over which they have little or no control.
User fee
The group has also suggested that user fee of all forms be dropped as a source of government revenue for financing health. While such fee has, in some instances, helped to a limited extent in deterring consumption of excessive and unnecessary medical care, they have not proven to be an effective source of resource mobilisation.
Drawing attention to inequities in resources among the States, the expert group has suggested introduction of specific purpose transfers to equalise the levels of per capita public spending on health across different States as a way to offset the general impediments to resource mobilisation and to ensure that all citizens have an entitlement to the same level of essential health care.
Also, it has said that the Centre should adopt a fiscal transfer mechanism that allows for flexible and differential financing to States to help meet the diverse requirements of the States.
Calling for ensuring availability of free essential medicines by increasing public spending on drug procurement, the report pointed out that low public spending on drugs and non-availability of free medicines in government health care facilities are major factors discouraging people from accessing public sector health facilities.
The group wanted the Ministry of Health and Family Welfare to be strengthened by bringing the drugs and pharmaceutical companies under its purview that would in turn strengthen the drug regulatory system.
Envisaging a major role for primary health care in the UHC system, the report has suggested earmarking at least 70 per cent of public expenditures, both in the short run and over the medium term, for preventive, promotive and primary health care. The district hospitals would be strengthened to take care of the major disease burden.
